Provider Demographics
NPI:1467073148
Name:CUMMINGS, MICHELLE C (CPHT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 BIRKSHIRE RDG
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-2000
Mailing Address - Country:US
Mailing Address - Phone:470-526-6057
Mailing Address - Fax:
Practice Address - Street 1:62 KEYS FERRY ST
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3298
Practice Address - Country:US
Practice Address - Phone:770-957-1851
Practice Address - Fax:770-957-7434
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHTC006298183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician